Provider Demographics
NPI:1134362551
Name:MARLA R. LANDER MD PROFESSIONAL CORP
Entity type:Organization
Organization Name:MARLA R. LANDER MD PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. PT ACCT.
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEWSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-370-8114
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1017
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:770-237-1831
Practice Address - Street 1:1313 E OSBORN RD
Practice Address - Street 2:STE. 213
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5678
Practice Address - Country:US
Practice Address - Phone:602-234-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology